What's in, what's out in the nation's health plan

WASHINGTON (AP) — Six years ago, candidate Barack Obama stood before Iowa voters and unveiled a plan designed to extend health care to all Americans.

"We can do this," he said with confidence. "The time has come for universal, affordable health care in America."

Three years ago, President Barack Obama signed into law a plan designed to extend coverage to more than 30 million uninsured people.

"This is what change looks like," he exulted.

Not so fast.

Obama's message now boils down to this: Be patient, not yet, adjust your expectations.

A look at how the scope of Obama's health-care plan has narrowed in recent years:

PUBLIC OPTION? Never mind.

Obama once trumpeted the idea of providing a public option in health care, in essence a government-run plan that would be one of many choices for people seeking affordable care. That idea, popular with liberals but opposed by conservatives and many moderates, never made it into the health-care law. In the quest for a workable compromise, Obama deemed it expendable.

LONG-TERM CARE INSURANCE? Buh-bye.

When the president signed his health-care plan into law, it included a proposal to provide basic long-term care insurance at an affordable cost. Before the program ever got off the ground, though, the administration ditched it last spring for fear it would turn into a financial drain. It could take be years before lawmakers to tackle the issue again.

COVERAGE FOR THE NEEDIEST? Not in every state.

The law envisioned millions of the neediest Americans gaining health insurance by enrolling in Medicaid, with coverage starting in January. But the Supreme Court threw a wrench in that plan last year when it gave states the right to opt out of the Medicaid expansion plan. Because of Republican opposition in many states, it looks like nearly 2 in 3 of those who would qualify for new Medicaid coverage may be out of luck because their state lawmakers have not agreed to expand the program.

WHAT ABOUT WORKERS? A longer wait.

The law requires companies with 50 or more workers to offer affordable coverage to full-time employees or risk a series of escalating tax penalties. Originally, that requirement was supposed to take effect on Jan. 1, 2014. But now the administration is pushing that requirement back a year, citing the complexity of the undertaking. Most medium and large business already offer health insurance. Those most likely to be affected by the delay: low-wage workers at hotels, restaurants and stores.

WHAT'S LEFT? Plenty.

Starting next year individuals will be required to carry health insurance or face fines. People who are uninsured will be able to shop for affordable coverage through online marketplaces. Middle-class people who don't have coverage through their jobs will use the marketplace to apply for tax credits to help pay their premiums. Low-income people will be steered to the Medicaid expansion — if their state participates. Insurance companies will be required to accept people regardless of their medical problems. A number of other changes already have taken effect, including a provision that allows young adults to stay on their parents' insurance until age 26 and a ban on lifetime limits on insurance coverage.